Rate-dependence of antiarrhythmic and proarrhythmic properties of class I and class III antiarrhythmic drugs. 1998

J Weirich, and H Antoni
Physiologisches Institut, Universität Freiburg i. Br, Germany.

Rate or frequency-dependence is a characteristic property of antiarrhythmic drugs belonging to the Vaughan William classes I and III. The rate-dependence of class I drugs (i.e., increasing blockade of fast Na(+)-channels with faster rates) results from periodical drug binding to Na(+)-channel sites which are preferably available in the activated and/or inactivated channel states (use-dependence). With respect to their binding and unbinding kinetics, class I drugs can be subdivided into three groups (group 1-group 3) which differ in their block-frequency relations as well as in their onset kinetics of channel blockade. These properties can serve as predictors of the anti- and proarrhythmic potential of class I drugs. Class III drugs (blockers of potassium channels) are mostly characterized by reverse rate-dependence (loss of class III action at faster rates). However, this property cannot be attributed to reverse use-dependence, i.e., binding to channels in the rested state. It is more likely due to different rate-dependent contributions of the two components of the delayed rectifier potassium current to repolarization, when the rapidly activating, the rectifying component IKr is specifically blocked by class III drugs, while the slowly activating component IKs remains unchanged. In spite of their reverse rate-dependence, class III drugs exert an antifibrillatory effect when fibrillation is induced by frequent stimulation. This can be attributed to the slow time course of the decline (offset kinetics) of the class III effect accompanying a sudden increase in frequency. Proarrhythmic effects of class III drugs result from the delay in repolarization that may favor the development of early afterdepolarizations. The proarrhythmic potential of class III drugs is species dependent and is favored if the contribution of IKr to the repolarization phase of the action potential is comparatively large.

UI MeSH Term Description Entries
D008024 Ligands A molecule that binds to another molecule, used especially to refer to a small molecule that binds specifically to a larger molecule, e.g., an antigen binding to an antibody, a hormone or neurotransmitter binding to a receptor, or a substrate or allosteric effector binding to an enzyme. Ligands are also molecules that donate or accept a pair of electrons to form a coordinate covalent bond with the central metal atom of a coordination complex. (From Dorland, 27th ed) Ligand
D006339 Heart Rate The number of times the HEART VENTRICLES contract per unit of time, usually per minute. Cardiac Rate,Chronotropism, Cardiac,Heart Rate Control,Heartbeat,Pulse Rate,Cardiac Chronotropy,Cardiac Chronotropism,Cardiac Rates,Chronotropy, Cardiac,Control, Heart Rate,Heart Rates,Heartbeats,Pulse Rates,Rate Control, Heart,Rate, Cardiac,Rate, Heart,Rate, Pulse
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000200 Action Potentials Abrupt changes in the membrane potential that sweep along the CELL MEMBRANE of excitable cells in response to excitation stimuli. Spike Potentials,Nerve Impulses,Action Potential,Impulse, Nerve,Impulses, Nerve,Nerve Impulse,Potential, Action,Potential, Spike,Potentials, Action,Potentials, Spike,Spike Potential
D000818 Animals Unicellular or multicellular, heterotrophic organisms, that have sensation and the power of voluntary movement. Under the older five kingdom paradigm, Animalia was one of the kingdoms. Under the modern three domain model, Animalia represents one of the many groups in the domain EUKARYOTA. Animal,Metazoa,Animalia
D000889 Anti-Arrhythmia Agents Agents used for the treatment or prevention of cardiac arrhythmias. They may affect the polarization-repolarization phase of the action potential, its excitability or refractoriness, or impulse conduction or membrane responsiveness within cardiac fibers. Anti-arrhythmia agents are often classed into four main groups according to their mechanism of action: sodium channel blockade, beta-adrenergic blockade, repolarization prolongation, or calcium channel blockade. Anti-Arrhythmia Agent,Anti-Arrhythmia Drug,Anti-Arrhythmic,Antiarrhythmia Agent,Antiarrhythmia Drug,Antiarrhythmic Drug,Antifibrillatory Agent,Antifibrillatory Agents,Cardiac Depressant,Cardiac Depressants,Myocardial Depressant,Myocardial Depressants,Anti-Arrhythmia Drugs,Anti-Arrhythmics,Antiarrhythmia Agents,Antiarrhythmia Drugs,Antiarrhythmic Drugs,Agent, Anti-Arrhythmia,Agent, Antiarrhythmia,Agent, Antifibrillatory,Agents, Anti-Arrhythmia,Agents, Antiarrhythmia,Agents, Antifibrillatory,Anti Arrhythmia Agent,Anti Arrhythmia Agents,Anti Arrhythmia Drug,Anti Arrhythmia Drugs,Anti Arrhythmic,Anti Arrhythmics,Depressant, Cardiac,Depressant, Myocardial,Depressants, Cardiac,Depressants, Myocardial,Drug, Anti-Arrhythmia,Drug, Antiarrhythmia,Drug, Antiarrhythmic,Drugs, Anti-Arrhythmia,Drugs, Antiarrhythmia,Drugs, Antiarrhythmic
D026941 Sodium Channel Blockers A class of drugs that act by inhibition of sodium influx through cell membranes. Blockade of sodium channels slows the rate and amplitude of initial rapid depolarization, reduces cell excitability, and reduces conduction velocity. Channel Blockers, Sodium,Sodium Channel Blocker,Sodium Channel Inhibitor,Sodium Channel Inhibitors,Blocker, Sodium Channel,Channel Blocker, Sodium,Channel Inhibitor, Sodium,Channel Inhibitors, Sodium,Inhibitor, Sodium Channel,Inhibitors, Sodium Channel

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